Health anxiety (hypochondria)

Introduction

Most of us worry about our health from time to time, and some of us have to manage serious medical conditions. But for some people, health worries become overwhelming and a problem in itself.

Hypochondria (health anxiety) is excessive worrying about your health, to the point where it causes great distress and affects your everyday life.

Some people with health anxiety have a medical condition, which they worry about excessively. Others have medically unexplained symptoms, such as chest pain or headaches, which they are concerned may be a sign of a serious illness, despite the doctor's reassurance.

Others may be permanently anxious about their future health, worrying about things like: "What if I get cancer or heart disease?"

What causes health anxiety?

There are many reasons why someone worries too much about their health.

You may be going through a particularly stressful period of your life. There may have been illness or death in your family, or another family member may have worried a lot about your health when you were young.

Personality can be a factor. You may be vulnerable to health anxiety because you are a worrier generally. You may find it difficult to handle emotions and conflict, and tend to "catastrophise" when faced with problems in your life.

Sometimes, health anxiety can be a symptom of a mental health condition, such as depression or anxiety disorder, which needs recognising and treating in its own right (see below).

Avoidant behaviour – avoiding medical TV programmes, GP appointments and anything else that might trigger the anxiety, and avoiding activities such as exercise that are perceived to make the condition worse.

Neither of these behaviours are helpful, and need addressing if you are to break the vicious circle of health anxiety.

Health anxiety can be a vicious circle

If you constantly check your body for signs of illness, such as a rash or bump, you will eventually find something. It often won't be anything serious – it could be a natural body change, or you could be misinterpreting signs of anxiety (such as increased heart rate and sweating) as signs of a serious condition. However, the discovery tends to cause great anxiety and make you self-check even more.

You may find yourself needing more reassurance from doctors, friends and family. The comfort you get from this reassurance may be short-lived, or you may stop believing it, which only means you need more of it to feel better. Seeking reassurance just keeps the symptoms in your head, and usually makes you feel worse.

When physical symptoms are triggered or made worse by worrying, it causes even more anxiety, which just worsens the symptoms. Excessive worrying can also lead to panic attacks or even depression.

Have I got health anxiety?

If you can answer "yes" to most of the following questions, it's likely that you are affected by health anxiety and might benefit from talking to your GP.

During the past six months:

Have you been preoccupied with having a serious illness because of body symptoms, which has lasted at least six months?

Have you felt distressed due to this preoccupation?

Have you found that this preoccupation impacts negatively on all areas of life, including family life, social life and work?

Have you needed to carry out constant self-examination and self-diagnosis?

Have you experienced disbelief over a diagnosis from a doctor, or felt you are unconvinced by your doctor's reassurances that you are fine?

Do you constantly need reassurance from doctors, family and friends that you are fine, even if you don't really believe what you are being told?

How your GP can help

Once your GP has established that you do suffer from health anxiety, and there is no serious underlying physical cause for any symptoms you might have, they should investigate whether you might have a problem, such as depression or anxiety disorder, that may be causing or worsening your symptoms.

If this is the case, you may be referred for psychological therapy and you may benefit from antidepressants (see below).

If this is not the case, the aim should still be to help you become less worried about your health. You may find that your GP's advice and self-help resources (see below) are all you need to start feeling better, or you may still benefit from a referral for psychological therapy.

Psychological therapy

It involves working with a trained CBT therapist to identify the thoughts and emotions you experience and the things you do to cope with them, with the aim of changing unhealthy thoughts and behaviours that maintain health anxiety.

CBT looks at how to challenge the way you interpret symptoms, to encourage a more balanced and realistic view. It should help you to:

learn what seems to make the symptoms worse

develop methods of coping with the symptoms

keep yourself more active, even if you still have symptoms

However, CBT is not the best treatment for everyone with health anxiety. Some people may benefit more from a different psychological therapy, such as trauma-focused therapy or a psychotherapy that will help a particular psychological condition.

Accurate assessment is needed to select the right treatment for you and for your problem, so, if necessary, you may be referred to a mental health specialist for this next step.

Medication

Antidepressants may be helpful if you have a mental health condition such as depression. For some people, these may work better than CBT. Your GP can directly prescribe antidepressants or refer you to a mental health specialist for treatment.

However, treating your symptoms with medication is not always the answer and the possible benefits of medication always need to be weighed against the potential negative effects.